[A multicenter study on respiratory pathogen detection with Mycoplasma pneumoniae pneumonia in children]

Objective: To analyze the status of respiratory pathogen detection and the clinical features in children with Mycoplasma pneumoniae pneumonia (MPP). Methods: A prospective, multicenter study was conducted to collect clinical data, including medical history, laboratory examinations and multiplex PCR tests of children diagnosed with MPP from 4 hospitals in China between November 15th and December 20th, 2023. The multiplex PCR results and clinical characteristics of MPP children in different regions were analyzed. The children were divided into severe and mild groups according to the severity of the disease. Patients in the severe group were further divided into Mycoplasma pneumoniae (MP) alone and Multi-pathogen co-detection groups based on whether other pathogens were detected besides MP, to analyze the influence of respiratory pathogen co-detection rate on the severity of the disease. Mann-Whitney rank sum test and Chi-square test were used to compare data between independent groups. Results: A total of 298 children, 136 males and 162 females, were enrolled in this study, including 204 children in the severe group with an onset age of 7.0 (6.0, 8.0) years, and 94 children in the mild group with an onset age of 6.5 (4.0, 7.8) years. The level of C-reactive protein, D-dimer, lactic dehydrogenase (LDH) were significantly higher (10.0 (5.0, 18.0) vs. 5.0 (5.0, 7.5) mg/L, 0.6 (0.4, 1.1) vs. 0.5 (0.3, 0.6) mg/L, 337 (286, 431) vs. 314 (271, 393) U/L, Z=2.02, 2.50, 3.05, all P<0.05), and the length of hospitalization was significantly longer in the severe group compared with those in mild group (6.0 (6.0, 7.0) vs. 5.0 (4.0, 6.0) d, Z=4.37, P<0.05). The time from onset to admission in severe MPP children was significantly shorter than that in mild MPP children (6.0 (5.0, 9.5) vs. 9.0 (7.0, 13.0) d, Z=2.23, P=0.026). All patients completed the multiplex PCR test, with 142 cases (47.7%) MPP children detected with 21 pathogens including adenovirus 25 cases (8.4%), human coronavirus 23 cases (7.7%), rhinovirus 21 cases (7.0%), Streptococcus pneumoniae 21 cases (7.0%), influenza A virus 18 cases (6.0%). The pathogens with the highest detection rates in Tianjin, Shanghai, Wenzhou and Chengdu were Staphylococcus aureus at 10.7% (8/75), adenovirus at 13.0% (10/77), adenovirus at 15.3% (9/59), and both rhinovirus and Haemophilus influenzae at 11.5% (10/87) each. The multi-pathogen co-detection rate in severe MPP children was significantly higher than that in mild MPP group (52.9% (108/204) vs. 36.2% (34/94), χ²=10.62,P=0.005). Among severe MPP children, there are 89 cases in the multi-pathogen co-detection group and 73 cases in the simple MPP group. The levels of LDH, D-dimer and neutrophil counts in the multi-pathogen co-detection group were significantly higher than those in the simple MPP group (348 (284, 422) vs. 307 (270, 358) U/L, 0.8 (0.5, 1.5) vs. 0.6 (0.4, 1.0) mg/L, 4.99 (3.66, 6.89)×109 vs. 4.06 (2.91, 5.65)×109/L, Z=5.17, 4.99, 6.11, all P<0.05). Conclusions: The co-detection rate of respiratory pathogens, LDH and D-dimer in children with severe MPP were higher than those with mild MPP. Among severe MPP children the stress response of children in co-detection group was more serious than that of children with simple MPP.

[Characteristics and related factors of viral nucleic acid negative conversion in children infected with Omicron variant strain of SARS-CoV-2]

Objective: To understand the characteristics and associated factors of viral nucleic acid conversion in children infected with Omicron variant strain of SARS-CoV-2 in Shanghai. Methods: The clinical symptoms, laboratory results and other data of 177 children infected with SARS-CoV-2 who were hospitalized in Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University (designated hospital for SARS-CoV-2 infection in Shanghai) from April 25 to June 8, 2022 were retrospectively analyzed. According to the chest imaging findings, the children were divided into mild and common type groups. According to their age, the unvaccinated children were divided into<3 years old group and 3-<18 years old group. According to the vaccination status, the children aged 3-<18 year were divided into non-vaccination group, 1-dose vaccination group and 2-dose vaccination group. Comparison between groups was performed by independent sample t-test and analysis of variance, and multivariate linear regression analysis was used for multivariate analysis. Results: Among the 177 children infected with Omicron variant of SARS-CoV-2, 96 were males and 81 were females, aged 3 (1, 6) years. The time of viral nucleic acid negative conversion was (10.3±3.1) days. The 177 children were 138 cases of mild type and 39 cases of common type. Among the children aged 3-<18 years old, 55 cases were not vaccinated, 5 cases received 1-dose and 36 cases received 2-dose vaccination. Among the 36 children who received 2 doses of vaccination, the time of viral nucleic acid negative conversion was shorter in those vaccinated within 6 months than those over 6 months ((7.1±1.9) vs. (10.8±3.0) d, t=-3.23, P=0.004). Univariate analysis showed that the time of nucleic acid negative conversion of SARS-CoV-2 was associated with age, underlying diseases, gastrointestinal symptoms, white blood cell count, proportion of neutrophils, proportion of lymphocytes, and the number of doses of SARS-CoV-2 vaccine (t=3.87, 2.55, 2.04, 4.24, 3.51, 2.92, F=16.27, all P<0.05). Multiple linear regression analysis showed that older age (β=-0.33, 95% CI -0.485--0.182, P<0.001) and more doses of vaccination (β=-0.79, 95% CI -1.463--0.120, P=0.021) were associated with shortened nucleic acid negative conversion time in children, while lower lymphocyte proportion (β=-0.02, 95% CI -0.044--0.002, P=0.031) and underlying diseases (β=1.52, 95% CI 0.363-2.672, P=0.010) were associated with prolonged nucleic acid negative conversion time in children. Conclusion: The children infected with Omicron variant of SARS-CoV-2 with reduced lymphocyte proportion and underlying diseases may have longer time of viral nucleic acid negative conversion,while children with older age and more doses of vaccination may have shorter time of viral nucleic acid negative conversion.

[COVID-19 treated with oral Nirmatrelvir-Ritonavir in 3 children]

Objective: To summarize the application experience and the therapeutic effect of Nirmatrelvir-Ritonavir (trade name: Paxlovid) for COVID-19 in children. Methods: A retrospective analysis was performed on the clinical data, including collecting the clinical manifestations and clinical outcomes, dynamically monitoring the blood routine, hepatic and renal function and SARS-CoV-2 nucleic acid results, and observing the related side effects during the treatment, etc, of 3 cases with COVID-19 treated with Paxlovid admitted to Shanghai Children's Hospital (designated referral hospital for SARS-CoV-2 infection in Shanghai) from May 1^st to June 1^st, 2022. Results: The 3 cases were 12, 14, 17 years of age, among which 2 cases were males, 1 case was female. All 3 cases were mild cases with underlying diseases and risk of developing into severe COVID-19, with symptoms of high fever, sore throat and dry cough. The treatment of Paxlovid at 3^rd day of symptom onset contributed to the symptom-free after 1-2 days and negative results of SARS-CoV-2 nucleic acid after 2-4 days. All patients had no adverse manifestations of gastrointestinal tract and nervous system but a case had little skin rashes, which recovered after the withdrawal of Paxlovid. Three cases had normal hepatic and renal function during the Paxlovid treatment. At 3 months after discharge, no clinical manifestations of post-COVID syndrome were found in all 3 cases. Conclusion: Paxlovid was effective and relatively safe in the treatment of 3 children with COVID-19.

High-frequency monitoring of neonicotinoids dynamics in soil-water systems during hydrological processes

Neonicotinoids pollution poses a serious threat to aquatic ecosystems. However, there is currently little knowledge about how neonicotinoids are transferred from the agricultural environment to the aquatic environment. Here, we conducted in situ high-frequency monitoring of neonicotinoids in soil-water systems along the hydrological flow path during rainfall to explore the horizontal and vertical transport mechanisms of neonicotinoids. The collected samples included 240 surface runoff, 128 subsurface runoff, 60 eroded sediment, 120 soil and 144 soil solution, which were used to analyse neonicotinoids concentrations. Surface runoff, subsurface runoff and eroded sediment were the three main paths for the horizontal migration of neonicotinoids. In the CK (citrus orchards without grass cover) and grass-covered citrus orchards, there are 15.89% and 2.29% of the applied neonicotinoids were transported with surface runoff, respectively. While in the CK and grass-covered citrus orchards, there are only 1.23% and 0.19% of the applied neonicotinoids were transported with eroded sediment and subsurface runoff. Although the amount of neonicotinoids lost along with eroded sediment was small, the concentration of neonicotinoids in eroded sediment was two orders of magnitude higher than the concentration of neonicotinoids in sediments of the surface water. Meanwhile, neonicotinoids migrated vertically in soil due to water infiltration. In the CK and grass-covered citrus orchards, there are 57.64% and 24.36% of the applied neonicotinoids were retained in soil and soil solution, respectively, and their concentration decreased as soil depth increased. Another noteworthy phenomenon is that more neonicotinoids migrated to deeper soil layers under grass cover compared with no grass cover because grass roots promoted the formation of cracks and vertical preferential flow. Our results are expected to improve the accuracy of neonicotinoids pollution prediction by considering migration paths, including surface and subsurface runoff and eroded sediment.

[Understanding of Smallpox in Ancient China]

Smallpox was believed afferent before the Sui Dynasty. Some relatively accurate descriptions about smallpox were found in the Sui and Tang Dynasties. Smallpox was recognized as a severe infectious disease caused by pathogenic heat by the observation of its symptoms and appearance. It was believed that smallpox was caused by the heat accumulation in the Zang-Fu organs in the early period of the North Song Dynasty. After that, it was believed caused by the fetus ingesting the filthy liquid from the mother as the prototype of the fetal poison theory. This means that ancient Chinese physicians were able to distinguish the differences among chickenpox, measles and smallpox at that time. The exogenous theory of fetal poison became the mainstream in the Ming and Qing dynasties. Smallpox, therefore, was confirmed not to be re-infected after once infection, and was specifically described with the symptoms and the precise prognosis. It can be seen that the understanding of smallpox by ancient Chinese physicians developed with time, and these understandings opened a way for the invention of the human pox vaccination.

[Zhu Yilin and his medical works]

Zhaixinglou Zhidou Quanshu (, Encyclopedia of Smallpox from the Star-Picking Pavilion) is considered as the epitome of theory and the experience collected of the doctors treating smallpox in Ming dynasty. There exists some mistakes and lack of detailed introductions about it and its author Zhu Yilin in some bibliographies. Zhu's style name is"Jixiang", and"Yingwo"is his art name. His most active time was during the reigns of Wanli and Chongzhen emperors. He learned medicine because of his illness and became good at treating smallpox. After failing to pass the Imperial examinations, he focused on practicing medicine. Zhu Yilin's printed medical works include Douyan Qulu Ji, Lundou Youxi Pian, Zhidou Dachengji (, Collections of Treating Smallpox), and his medical records. There are the preface of 1st Year of Tianqi Reign wood-block edition, and 2 copied manuscripts, one in Japan and the other in Taiwan. Zhu's descendant Zhu Fa and Zhu Cun collected his works above and compiled as one book, renamed its name to Zhaixinglou Zhidou Quanshu during Qianlong and Daoguang Reign and printed it in 1826, which is called the Daoguang Gengletang edition. Some reference books and textbooks mistake it as compiled in 1619, printed in 1743 or 1765. In addition, Fu Zhichao Zhongdouxinfa (, Supplemented Extracts of Variolation Methods) in Zhaixinglou Zhidou Quanshu was mainly based on Youke Zhongdou Xinfa Yaozhi (, Pediatric Variolation Essentials), and extracted many books like Douzhen Dinglun (, Verdict on Smallpox).

[On the name and authorship of Yi Lüe Zheng Wu Gai Lun]

Yi Lüe Zheng Wu Gai Lun(, Introduction of Corrections to Summaries on Medicine) was written around 1545, the 24th year during Emperor Jiajing's reign in the Ming Dynasty, now it has the only copy extant. Some errors and mistakes happened about this book name and its author in some history books and bibliographies: some reference books describe Yi Lüe Zheng Wu Gai Lun and Yi Lüe Zheng Wu (, Corrections to Summaries on Medicine) as two different books, with their own writer Li Xiang and Li Hanyi respectively. In fact, there is only one book, Yi Lüe Zheng Wu Gai Lun and Yi Lüe Zheng Wu is same book. The author is Li Xiang, but Hanyi is his courtesy name that misunderstood as a different person.

[Foreign members and their researches on Chinese medical history in early Chinese Society of Medical History]

Foreign members of Chinese Society of Medical History were more than one-third in Republic of China. But they have not gotten enough attention. This paper introduces their life, and researches on history of medicine of 13 foreign members, includes B. E. Read, Edward.H.Hume, L. S. Huizenga, W. W.Cadbury, H. G.Earle, Frederick Reiss, Maxwell, J.L, W. R.Morse, C. N. Frazier, T. C.Greene, Franz Hübotter, L. G.Kilborn, H. E.Sigerist. Their researches on Chinese medical history played an important role in the western society knowing about traditional Chinese medicine and its medical culture.

[The traditional Chinese Medicine-The points of view from a Russian doctor in the mid-nineteenth century]

Doctor of Medicine Tatarinov(Татаринов) came to China, as a member of the Russian Orthodox Mission(also known as the Russian Ecclesiastical Mission). He wrote a report on Chinese medicine in 1855. In its preface, he recorded in detail and commented the books of medicine in China, the status of Chinese physicians, and their services of diagnosis and therapy. The records of the clinics in Beijing, its diagnostic fee and service way of the practitioners were very rare in other literatures. Its comments on traditional Chinese medicine reflected western doctors' ideas at that time. His view came from unique angle, and had high value on the study of Chinese medicine history.

[Medical education in China in early Republic of China and Japan]

In 1912, with reference to the educational system of Japan, the Ministry of Education of the Republic of China issued the Regulation of Medical College, and established the first national medical institution of higher medical education, the Peking Medical Special College. Thereafter, public institutions of Medical Special School were also set up by some local government, such as Jiangsu and Zhejiang, etc. These public and national special medical schools and colleges were all established by the returned medical students studying in Japan, and they copied the model of Japanese medical education, including using the curricula of medical college of Japan, employing Japanese teachers, translating Japanese textbooks and buying Japanese experimental samples and apparatuses, all followed the Japanese models. In a manner of speaking, taking Japan as the template, educational system of western medicine was established in China in early Republic of China. In 1923, learning from that of the United States, a new educational medical system was set up, the medical education in China was further in line with the world.

[ZHANG Zhongyuan (), President of Imperial Academy of Medicine in the Qing Dynasty]

The Imperial Academy of Medicine (IAM) was the central medical administrative authority, responsible for the promulgation and implementation of national medical policies. It also was the medical educational institution that trained physicians. The imperial government isolated the physicians at the IAM from the outside world. Therefore, records about them are rare. By studying official archives such as Juezhi Quanlan 《》, Jinshen Quanshu 《》 and Qing Dynasty Imperial medical archives, etc, we provide a brief biography of Zhang Zhongyuan, the last chief administrator of the IAM, and present his rise from the lowest rank of physician to chief administrator. We also discuss his medical activities, diagnosis and treatments for the Imperial family, especially for Empress Dowager Cixi () and Emperor Guangxu (), as well as the management and reforms he advocated for the IAM. Through an analysis of the case of Zhang Zhongyuan, we can have a glimpse of the real life of imperial physicians.

[Overexpression, homology modeling and coenzyme docking studies of the cytochrome P450nor2 from Cylindrocarpon tonkinense]

Cytochrome P450nor catalyzes an unusual reaction that transfers electrons from NADP/NADPH to bound heme directly. To improve the expression level of P450nor2 from Cylindrocarpon tonkinense (C.P450nor2), Escherichia coli system was utilized to substitute the yeast system we constructed for expression of the P450nor2 gene, and the protein was purified in soluble form using Ni(+)-NTA affinity chromatography. In contrast to P450nor from Fusarium oxysporum (F.P450nor) and P450nor1 from Cylindrocarpon tonkinense (C.P450nor1), C.P450nor2 shows a dual specificity for using NADH or NADPH as electron donors. The present study developed a computational approach in order to illustrate the coenzyme specificity of C.P450nor2 for NADH and NADPH. This study involved homology modeling of C.P450nor2 and docking analyses of NADH and NADPH into the crystal structure of F.P450nor and the predictive model of C.P450nor2, respectively. The results suggested that C.P450nor2 and F.P450nor have different coenzyme specificity for NADH and NADPH; whilst the space around the B'-helix of the C.P450nor2, especially the Ser79 and Gly81, play a crucial role for the specificity of C.P450nor2. In the absence of the experimental structure of C.P450nor2, we hope that our model will be useful to provide rational explanation on coenzyme specificity of C.P450nor2.

Association of beta-adrenoceptor single nucleotide polymorphisms with resting heart rate

The association of beta-adrenoceptor (B-AR, including three subgroups: Beta1, Beta2 and Beta3) single nucleotide polymorphisms (SNP) with resting heart rate (RHR) were analyzed. RHR of 107 healthy subjects in the supine were detected by computerized system for 8 minutes. Genotyping SNPs of S/G49 and R/G389 of Beta1-AR and W/R64 of Beta3-AR in these subjects were by means of PCR-restriction fragment length polymorphism (PCR-RFLP) technique. Genotyping SNPs of R/G16 and Q/E27 of Beta1-adrenoceptor in these subjects were by means of allele specific primer-PCR (ASP-PCR) technique. It was found that there was no significant difference among RHRs corresponding above SNPs of B-AR, but the SNP of R/G389 of Beta1-AR, in which there was significant difference among RHRs (P<0.05). Either in the female individuals or in the male, those with Beta1-AR G/G389 genotype had the highest RHR. The females with R/R389 genotype had the lowest RHR, however, the males with R/G389 genotype had the lowest RHR. The RHR was not only associated with R/G389 polymorphism of Beta1-adrenoceptor gene significantly, but also was associated with gender in Chinese.

Protective effects of Ginkgo biloba extract on cultured rat cardiomyocytes damaged by H2O2

AIM

To investigate the influence of Ginkgo biloba extract (GbE) on cardiomyocytes damaged by H2O2.

METHODS

Cultured rat cardiomyocytes were divided into 3 groups randomly: control group; H2O2 (2.5 mmol.L-1) group; H2O2 2.5 mmol.L-1 + GbE 150 mg.L-1 group. The cardiomyocytes were cultured in MEM (Eagle's) at 37 degrees C in the presence of 5% CO2 for 4 h. Lactate dehydrogenase (LDH) was assayed by colorimetric method. Lipid peroxidation was determined by measuring thiobarbituric acid-reactive substances. Ultrastructure was viewed under transmission electron microscope.

RESULTS

Compared with the control group, LDH leakage and malondialdehyde (MDA) content increased in H2O2 group, LDH increased from (2166 +/- 247) U.L-1 to (5180 +/- 648) U.L-1, MDA increased from (3.5 +/- 0.2) nmol/10(6) cells to (7.2 +/- 0.4) nmol/10(6) cells (P < 0.01). The ultrastructure was damaged seriously. GbE inhibited the increase of LDH leakage and MDA content induced by H2O2. In this group, LDH decreased from (5180 +/- 648) U.L-1 to (3496 +/- 386) U.L-1, MDA decreased from (7.2 +/- 0.4) nmol/10(6) cells to (4.8 +/- 0.9) nmol/10(6) cells (P < 0.01). Ultrastructure of cells was also protected by GbE.

CONCLUSION

GbE protected the cardiomyocyte against H2O2 injury, the protective action was attributed to its antiperoxidative effect.